When the Doctor Dismisses Your Concerns
Jan. 20, 2023 â Preslee Marshall, a 25-year-old resident of Canada, began having severe electric shock-like sensations shooting throughout her body. It started happening once a week, then progressed to once a day, then multiple times a day, she says. Worried, Â Marshall, who co-manages a public relations agency, consulted a neurologist.Â
âHe told me my symptoms were caused by anxiety. He said, âIf you get your nails done, youâll feel better,â which shocked me,â she says. âBut I took his advice, got my nails and hair done, went for a massage and got a facial, and my pain kept getting worse.â
Eventually, Marshall was diagnosed with fibromyalgia â a long-lasting condition that often causes pain and tenderness throughout the body â by a rheumatologist after a thorough examination and an MRI to rule out other serious conditions, like multiple sclerosis, which can have similar symptoms.
Lorrie Lewis, a 56-year-old social worker, was also brushed off by her doctor. Her daughter, Beth DeCapua, a house painter in Toms River, NJ, says her mother had consulted a doctor because she was having a hard time coordinating her hands while trying to dust the coffee table.
âThe first doctor my mother saw said, âYouâve got to expect this at your age,â and when she went to a second doctor, he advised her to go home and relax with a glass of wine,â DeCapua recalls. Two years later, Lewis was diagnosed with Parkinsonâs disease, which eventually claimed her life.
Obadiah J., a clergyman from New York who asked that his last name not be used for this article, began feeling âterrible heartburnâ when he was 15. He consulted a doctor who told him that young men “don’t get heartburn.”Â
âIt wasnât until I got married and my wife introduced me to a gastroenterologist that I got diagnosed with a hiatal hernia and an inflamed esophagus,â he says.Â
Having oneâs symptoms dismissed by a health care professional is sometimes called âmedical gaslighting,â a term that comes from Gas Light, a 1938 play that was later adapted into a movie, in which the husband manipulates his wife into questioning her perceptions of reality and her sanity.
Karen Lutfey Spencer, PhD, a professor of health and behavioral sciences at the University of Colorado in Denver, says that  while âmedical gaslightingâ has become a popular term to describe the downplaying or dismissing a patientâs symptoms, it may be a label that’s not accurate.
âThe word âgaslightingâ implies that someone is purposefully trying to mess with another personâs head, as the husband did in the movie. But we have many well-intentioned health care providers who are not deliberately trying to âgaslightâ their patients,â she says. That said, the absence of malice doesnât justify dismissing a patientâs symptoms, she notes.Â
‘Horses’ vs ‘Zebras’Â
In medical school, doctors are taught, âIf you hear hoofbeats, think horses, not zebras.â This encourages providers to look for the most common rather than the most exotic diagnosis for a personâs condition. But that approach might unintentionally lead to downplaying a patientâs symptoms â especially in todayâs high-pressure health care environment, where providers are forced to quickly find out what the patientâs problem is.Â
So, why would common conditions like fibromyalgia, Parkinsonâs, and a hiatal hernia be considered âzebrasâ?Â
Spencer, a medical sociologist whose research focuses on medical decision-making, health care disparities, and patient-provider relationships, says that some providers have biases that affect their diagnoses and treatment decisions.
âResearch has shown that women, people of color, older people, non-heterosexual people, and individuals with âstigmatizedâ conditions â like being overweight or having a mental illness â are more frequently misdiagnosed and their symptoms are more frequently dismissed,â she says.Â
One reason is that much of the research that informs diagnosis and treatment was historically performed on white males. âThereâs much less research into other populations with other biologies. Itâs assumed that what is known about white males will translate into other groups, and thatâs simply not always true,â Spencer explains.
For example, heart problems are often misdiagnosed in women because heart disease has been regarded as a âmaleâ condition.
âA doctor in one of my studies once reported that that the encyclopedia he used in medical school to learn about angina had an illustration of an elderly gray-haired white man clutching his chest. This picture, which hasnât changed in decades, reinforces the message that heart disease is a white male problem.â
These various kinds of influences become âbaked into medical training.â So when a woman has heart symptoms, â[doctors] may be less certain that itâs a heart problem and give more consideration to other causes, like stress or depression,â says Spencer.
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Similarly, Parkinsonâs disease statistically affects more men than women, so some doctors may not think of it in a woman who has symptoms, suggests Christine Metz, PhD, a professor in the departments of Obstetrics and Gynecology and Molecular Medicine at Hofstra/Northwell, Long Island, NY.
Common But Hard to Diagnose
Certain types of illnesses are more likely to be missed or dismissed, according to Allyson Shrikhande, MD, chief medical officer and co-founder of Pelvic Rehabilitation Medicine, a national womenâs health care company that specializes in pelvic pain.
Endometriosis is a condition that causes pelvic pain, and though itâs very common â 1 in 9 women are affected â there are no definite lab tests or X-rays to diagnose the condition, which is often diagnosed only during surgery.Â
âWomen experience pain in the lower abdomen, often during intercourse, and theyâre told by their physicians to relax and have a glass of wine, that theyâre simply overanxious. Theyâre made to feel crazy,â Shrikhande says.
One of the main reasons is lack of education about chronic pelvic pain â and similar conditions â during medical school and residency. Insufficient education can lead to even a common condition being regarded as a âzebra,â according to Shrikhande. This is true for other conditions as well, such as fibromyalgia.
Myths and Facts About Pain
Pain similarly has no âobjectiveâ measurement technique, according to Metz.Â
âYes, people are asked to report their pain on a 1-10 âpain scale,â but itâs still very subjective. A level 1 or 2 pain to me might be different from a level 1 or 2 pain for you,” she says.Â
And a lot of myths abound, despite scientific evidence to the contrary â for example, that Black people have a higher pain threshold than white people â leading to their pain complaints being taken less seriously in medical settings, says Tina Sacks, PhD, an associate professor at the University of California-Berkeleyâs School of Social Welfare.
Sacks, a social scientist who specializes in racial inequities in health, has written a book called Invisible Visits: Black Middle-Class Women in the American Healthcare System. She notes that pain in women is also more frequently underestimated and undertreated, compared to pain in their male counterparts.
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Spencer says sheâs been told by female athletes âthat when theyâve sought treatment for an injury, they were told to go home and use ice or take ibuprofen, while their male counterparts with similar injuries were more aggressively treated.â
Sacks agrees. âThereâs still some version of women being seen as âhystericalâ â and providers sometimes assume that the pain is a product of that âfemale hysteria.ââ
According to Sacks, people with âintersectionalityâ â for example, people who are both Black and female â are even more vulnerable because both groups are taken less seriously when they complain about medical symptoms such as pain.
She notes that people with disabilities are among the most at risk for medical gaslighting.Â
âAgeism, sexism, and ableism go hand-in-hand in the medical field, and these factors sometimes work together to effectively minimize or even negate altogether what the person is experiencing,” Sacks says, noting that immigrants are often taken less seriously as well.Â
Signs of Medical Gaslighting
âUnaddressed pain â or, for that matter, the downplaying or denial of any symptoms youâre describing â is a red flag,â says Spencer. And âbe concerned if your questions arenât being answered or are rerouted.âÂ
The experts point to phrases that can be âwarning bellsâ of gaslighting:
- âItâs all in your head.â
- âYour pain is manageable.â
- âYouâre just tense.â
- âYouâre too young to be feeling â â
- âYouâve got to expect this as you age.â
- âAll you need to do is lose some weight.â
- âItâs just your depression.â
Spencer notes that providers donât always agree with their patientsâ proposed plans of action, but that doesnât necessarily equate to gaslighting.Â
âA doctor may not want to perform a specific test you think you need or may believe your hypothesis is incorrect, but he or she should at least take your concerns seriously and explain why the test or treatment isnât appropriate,” she says.Â
When you leave a providerâs office, you should feel respected and validated. Feeling disrespected, trivialized, downplayed, or invalidated is another warning sign.Â
Protecting Yourself from Medical Gaslighting
Spencer recommends bringing a trusted friend or family member to medical appointments â especially someone who has been with you when youâve had your symptoms.Â
âItâs harder to dismiss two people than it is to dismiss one person, and your âbuddyâ can advocate for you,” she says.Â
Keeping a diary of your symptoms and writing down all of your questions in advance can also be helpful, Spencer advises.Â
âYou can say, âI kept a record of my symptoms, and I know my body. What Iâm experiencing isnât normal for me,'” Having a written list of questions not only helps with remembering your concerns but also conveys a sense of organization and thoughtful planning that make it harder for a provider to brush you off.
Metz recommends returning to questions on your list that you feel were not taken seriously enough.Â
For example, this can look like, âI want to go back to something I mentioned earlier. Why do you think Iâm having pain in the middle of my cycle?”
It might also be helpful to take notes on what the provider is saying, says Marshall. Youâre less likely to be told to âget your nails doneâ if the provider knows everything is being written down.
Obadiah records medical appointments. Not only does this make the doctor more accountable, but itâs easier for him to remember what the doctor said.Â
But remember that there are laws in certain states prohibiting recording without the other personâs knowledge or permission, Metz warns, so donât record unless youâve asked the doctor if itâs OK to do so.
And, if at all possible, ask to have your conversation with the doctor when you are dressed rather than when youâre sitting in the examining table in a skimpy hospital gown, Sacks advises.Â
Thereâs already a power differential between a patient and a doctor, and you feel much more vulnerable when the other person is dressed and youâre half-naked.â
Lastly, âif you continue to feel uncomfortable, seek another opinion,â Spencer suggests. Sometimes the health care system can be intimidating, and if you donât feel well, you may not want to go through the hassle of finding a new provider. But itâs important not to allow the providerâs dismissive attitude to deter you from getting to the bottom of whatever is going on with your health.
Support groups can be helpful. Marshall has joined communities of people with fibromyalgia, who have provided validation, support, resources, and practical information. And support groups can also help you find a professional whoâs specialized in your particular condition, Shrikhande notes.Â
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